5900-49 Geothermal Heat Pumps Data Collection Form

		Expiration Date: 1/31/2022
United States
ENVIRONMENTAL PROTECTION AGENCY
Washington, D.C. 20460
ENERGY STAR Geothermal Heat Pumps Partner Unit Shipment Data for Calendar Year 2020
Office of Atmospheric Programs
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0528). Responses to this collection of information are voluntary (Section103(g) of the Clean Air Act). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 17.5 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.
PARTNER NAME (Per your Partnership Agreement):				← Partner Name incomplete
SUBMITTED BY (Your name):				← Submitted By incomplete
IMPORTANT: Please read these instructions carefully before completing this form.
• Report shipments to or within the U.S. of all models certified under your ENERGY STAR partnership.
• To ensure no double counting occurs, do not report shipments of products certified under another company’s partnership, even if you are the Original Equipment Manufacturer of those products. As a reminder, any product sold under a brand name your company owns or licenses must be certified under your ENERGY STAR partnership.
This form is programmed to calculate your total shipments. Therefore, EPA strongly encourages you to complete it using Microsoft Excel instead of filling out a printed copy. Estimates of shipments are not accepted. Product Type definitions are available in the Program Requirements at www.energystar.gov/specifications.
If you shipped zero ENERGY STAR certified models to or within the U.S. in 2020, please check here and leave the table below blank.			← Check box indicating zero shipments OR report shipments
Reporting Period: CALENDAR YEAR 2020 (JAN. TO DEC.)
Geothermal Heat Pump Product Type	ENERGY STAR® U.S. Unit Shipments
Open Loop Systems	-
Open Loop Water-To-Air
Open Loop Water-To-Water
Closed Loop Systems	-
Closed Loop Water-To-Air
Closed Loop Water-To-Water
Direct Geoexchange Systems	-
DGX-To-Air
DGX-To-Water
Total	-
Submission Deadline: March 1, 2021
Please submit to ICF:	Or	To AHRI:
Katie Veasey		(This option is available only to AHRI members)
ICF
2550 S Clark St
Suite 1200
Arlington, VA 22202
unitshipmentdata@energystar.gov
Do not submit form to both AHRI and ICF
EPA Form No. 5900-49 OMB Control No. 2060-0528 EPA plans to use the data only for program evaluations. EPA will release this information only as aggregated data and only to the extent required by law.